Breed:
_______________________Sex:_________Call
Name:__________________ |
AKC Registered
Name: _________________________________________________ |
AKC #:
____________________________ Date of Birth:
______________________ |
Breeders:
___________________________________________________________ |
Owners: (as
appears on AKC Reg.)
________________________________________ |
Owners Address
(as appears on AKC Reg.)
_________________________________ |
_________________________________________________________________ |
Country of Birth:
________________ Current # of Points: _______ as of
date: _______ |
Majors:______________ Judges awarding Majors:
___________________________ |
Sire:
_______________________________________________________________ |
Dam:
______________________________________________________________ |
|
Date of most
recent inoculations: (Please supply a copy of shot
records, including Rabies)
_____________________________________________________________ |
Date of most
recent deworming: ____________________ Product used:
___________ |
Special Issues
for Dog: (Health, Temperament, etc.) ___________________________ |
_________________________________________________________________ |
Name, Address &
Phone Number of Dog's Treating Veterinarian:
_________________ |
_________________________________________________________________ |
Owner Responsible
for Bill:
______________________________________________ |
Street Address:
(Street, City, State & Zip):
___________________________________ |
_________________________________________________________________ |
Mailing Address:
(P.O. Box, City, State & Zip):
________________________________ |
_________________________________________________________________ |
Owner Home Phone:
________________ Work: ___________ Cell:
______________ |
Owner Email:
_________________________________________________________ |
Date:
__________________ Owner Signature:
_______________________________ |
Date:
__________________ A. Candy Carswell:
_____________________________ |
|
|